PT -期刊文章盟-瑞安缪尔盟Suradech Suthiphosuwan AU - Aditya Bharatha AU -艾米林盟-大卫·穆尼奥斯AU -马里奥·奥斯托夫斯基盟拉斐尔施耐德TI -可逆小血管血管炎和脑炎的抗逆转录病毒抵抗:中枢神经系统的表现艾滋病病毒逃避(2255)DP - 2020年4月14日TA -神经病学PG - 2255 VI - 94 IP - 15补充4099 - //www.ez-admanager.com/content/94/15_Supplement/2255.short 4100 - //www.ez-admanager.com/content/94/15_Supplement/2255.full所以Neurology2020 4月14日;首页94 AB -目的:NABackground: 58岁的男人艾滋病毒长期存在了5个月的进步的历史认知功能障碍和步态不稳。他是附着高活性抗逆转录病毒疗法(HAART)。CD4细胞计数前三个月出现症状已经560细胞/μL检测不到病毒载量。神经系统检查,他在蒙特利尔认知评估中得分20/30 (MoCA)和附属物的步态共济失调。核磁共振大脑T2-FLAIR显示弥漫性脑白质病。后t1影像展示了广泛的血管周的/ perivenular钆增强包括皮下、室周的白质。我们的差异包括结节病、淋巴瘤,自身免疫性GFAP astrocytopathy,等机会性感染肺结核。然而,系统性的检查和CSF分析这些都是负面的。病人后来开始推测炎症病因强的松。 Clinical and radiographic improvement was noted over the following weeks.Design/Methods: NAResults: Two months later, when prednisone was tapered, his symptoms worsened, and repeat MRI showed reemergent perivascular/perivenular gadolinium enhancement. His serum viral load increased to 980 copies/mL and he had developed elvitegravir resistance, so HAART was subsequently changed to bictegravir and darunavir. Brain biopsy revealed a mild encephalitis with small vessel vasculitis with prominent CD8+ T cell involvement of the small veins and no infarctions. No infectious, granulomatous, or malignant cause was identified.Eight weeks after the new HAART regimen was initiated, his MoCA improved to 27/30, ataxia improved, and the perivascular/perivenular enhancement resolved.Conclusions: We describe a rare pattern of vasculitis and encephalitis in HIV manifesting primarily as a CD8+ T-cell perivenular inflammatory response. Our patient’s clinical and radiographic response to a new HAART regimen suggests an HIV driven mechanism of vasculitis. We hypothesize his presentation emerged in response to high CSF HIV viral replication because of HAART resistance. His neuroimaging resembles previous reports of “HIV CNS escape”, a condition that is both rare and potentially treatable.Disclosure: Dr. Muir has nothing to disclose. Dr. Suthiphosuwan has received research support from Sanofi-Genzyme.Dr. Bharatha has nothing to disclose. Dr. Lin has nothing to disclose. Dr. Munoz has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Cortexyme. Dr. Ostrowski has nothing to disclose. Dr. Schneider has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Biogen.